Provider Demographics
NPI:1760141345
Name:PERRY, HEATHER MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MORGAN
Last Name:PERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11672 LARGO CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3973
Mailing Address - Country:US
Mailing Address - Phone:909-809-8497
Mailing Address - Fax:
Practice Address - Street 1:6072 SKYMEADOW WAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3951
Practice Address - Country:US
Practice Address - Phone:530-877-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist